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NPI Code Detail

MEDICARE: JESSICA SMITH

MEDICARE: JESSICA SMITH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1172V00000XCommunity Health Worker
23747P1801XPersonal Care Attendant

General Provider Information

NPI Number : 1740859719
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA SMITH
Provider Business Mailing Address
First Line : 200 ASSOCIATION DR
Second Line :
City : CHARLESTON
State : WV
Zip : 25311-1277
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 200 ASSOCIATION DR
Second Line :
City : CHARLESTON
State : WV
Zip : 25311-1277
Country : US
Telephone Number : 304-680-7414
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2021
Last Update Date : 06/26/2026

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Directions to “ JESSICA SMITH ” Practice Location

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